CHARGED UP BULLS 12U CHEER REGISTRATION

Parent/Guardian First Name:(Required)

Parent/Guardian Last Name:(Required)

Parent/Guardian Cell Phone:(Required)

Email:(Required)

Parent/Guardian 2 First Name:

Parent/Guardian 2 Last Name:

Parent/Guardian 2 Cell Phone:

Parent/Guardian 2 Email:

First Name:(Required)

Middle Name:

Last Name:(Required)

Child Date of Birth(Required)

School:(Required)

Grade:(Required)

Address:(Required)

Address 2:

City:(Required)

State:(Required)

Zip / Postal:(Required)

Upload Cheerleader Headshot(Required)

Drop files here or

Max. file size: 1 GB.

Proof of Age(Required)

Drop files here or

Max. file size: 1 GB.

Primary Emergency Contact Name:(Required)

Primary Emergency Contact Phone Number:(Required)

Primary Emergency Contact Relationship to Cheerleader:(Required)

Secondary Emergency Contact Name:

Secondary Emergency Contact Phone Number:

UPLOAD PROOF OF PHYSICAL(Required)

Max. file size: 1 GB.

Does the cheerleader have any allergies that we need to be aware of? *(Required)

Does the cheerleader have any other medical conditions that we need to be aware of? *(Required)

If you answered yes please explain:

REGISTRATION(Required)

Price:

Payment Method*

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